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Organization
FLORIDA MEDICAL AND DIAGNOSTIC CENTER
Active
Organization
FLORIDA MEDICAL AND DIAGNOSTIC CENTER
Active
Other names
FLORIDA MEDICAL AND DIAGNOSTIC CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BOGOMOLOVA YULIA (MEDICAL DIRECTOR)
(954) 302-3048
Entity
Organization
Contact information
Practice address
3020 NE 32ND AVE STE 305, FORT LAUDERDALE, FL 33308-7204
(954) 302-3048
(718) 554-1666
Mailing address
3020 NE 32ND AVE STE 305, FORT LAUDERDALE, FL 33308-7204
(954) 302-3048
(718) 554-1666
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9238727
LIC
FL
Enumeration date
06/19/2019
Last updated
06/19/2019
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